Description
A questionnaire is a research instrument consisting of a series of questions and other prompts for the purpose of gathering information from respondents. Although they are often designed for statistical analysis of the responses, this is not always the case. The questionnaire was invented by Sir Francis Galton.
4/11/2002
Page 1
Position Description Questionnaire
State of Nebraska DAS State Personnel
Office Use
Agency Information Agency: Division: Classification Information Current Class Title: Class Code: Salary Grade: Requested Class Title: Class Code: Salary Grade: Employee Information Employee Name: Employee Work Location: Employee Phone Number: Supervisor Information Immediate Supervisor Name: Supervisor Class Title: Supervisor Work Location: Supervisor Phone Number: Management completes this section This classification request is:
1. 2. 3. 4. Employee Initiated to Reclassify a Position for Position Number: Date submitted to DAS – State Personnel Division: OR OR Management Initiated to Create a Position OR OR State Personnel Initiated for Class Study or Update
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Introduction to the Position Description Questionnaire
In completing this questionnaire, please respond to every section that applies to your position. After you complete the questionnaire, your supervisor and others will review it for completeness and accuracy, when they complete the “Supervisor’s and Management’s Review” section. Your responses are used to determine the ranking of your position relative to others in State government and aid in the operation of other human resource management activities. Your responses, therefore, need to be as complete and accurate as possible. They will not be used to evaluate your job performance, nor be seen as limiting the authority of an agency head or supervisor to assign work.
GENERAL INSTRUCTIONS (Please read these directions carefully.)
Before answering each section, please read through the entire questionnaire. If further space is needed to answer a section completely and accurately, please attach additional pages. If a section does not apply to your position, answer “not applicable or N/A.” Please type or, if you prefer, legibly write your responses onto the questionnaire.
1. Essential Duties of the Position:
In the first column of the table “List of Essential Duties Performed” on the next page, please describe the essential duties of this position in clear, concise statements. Begin each essential duty statement with an action verb such as: Drives, Conducts, Repairs, Files, Types, Answers, Summarizes, and Interprets. Avoid words having unclear meanings such as Assists, Performs, Provides, Handles, Maintains, Participates, and Deals with. Use examples if they would make the duties described more clear. Then, for each of these duties, mark the proper response under each of the next three columns using the following guidelines: • Percentage of Time: Estimate the percentage of time spent performing each duty. Do not include a duty which occupies less than 5% of your time unless it is essential to the position. The total of all percentages should account for between 90% and 100% of the position’s time. Whether you perform this duty on a daily, weekly, monthly, quarterly, or annual basis, the following chart will help you estimate the percent of time you spend doing it. Daily 1/2 hour 1 hour 1 1/2 hours 2 hours 2 1/2 hours Weekly 2 hours 4 hours 6 hours 8 hours 10 hours Monthly 1 days 2 days 3 1/2 days 4 1/2 days 5 1/2 days Quarterly 3 days 6 1/2 days 10 days 13 days 16 days Annually 2 1/2 weeks 5 weeks 8 weeks 10 weeks 13 weeks
Percentage 5% 10% 15% 20% 25% •
Most Critical: Rate how critical each duty is to the position’s overall work objectives. Use a rating scale of 1 to 5 (ranging from 1 being most critical to 5 being least critical). Duties performed infrequently or that do not involve a large amount of time may still be critical to the position. The same rating may be given to more than one duty. Newly Assigned Duty: Place a check mark (? ) in this column for those duties that have been newly assigned in the last six months and/or have been added since the last classification review.
•
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List of Essential Duties Performed
(see previous page for coding instructions for each column) Percentage Critical New Duty
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2. Data/Information Used:
a. List below the type(s) of reports, documents, charts, graphs, payments, etc., received and/or reviewed in the performance of your duties. Beside each item, briefly describe the purpose or reason you receive and/or review it. Then state what you do with it and/or the data/information contained in it, after it is received and/or reviewed. Purpose or Reason for Receiving It What is Done With It
Type of Record, Report, Chart, Etc.
b. List below the type(s) of records, reports, charts, graphs, etc. prepared in the performance of your duties. Beside each item, briefly describe the purpose of the document. Then state what is done with it after it is prepared. Type of Record, Report, Chart, Etc. Purpose or Reason for Preparing It What is Done With It
c.
List below the type(s) of manuals, texts, drawings, documents, etc., which are referred to or used in the performance of your duties. Beside each item, briefly describe the purpose for which you refer to it. Purpose for which it is Referred to
Type of Manual, Book, Drawing, Etc.
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3. Interpersonal Communication/Interaction:
a. List those persons or groups with whom communication occurs in the performance of your duties. Beside each person, group, or organization listed, state the purpose for which the communication and/or interaction occurs. Purpose of Communication/Interaction
Person/Group with Whom Communication/Interaction Occurs
b. List the names and job titles of individuals you directly supervise. Beside each listing, note whether these are part- time or full-time positions, and, where applicable, the number of staff directly supervised by these individuals. Person(s) You Directly Supervise His or Her Job Title Part Time or Full Time Number of Staff He or She Supervises
c.
If your position involves leadership, supervisory, or managerial responsibilities for other staff, check (? ) below in the first two columns of boxes the responsibilities assigned to you on an on-going basis. Then check your level of involvement in supervising/managing employees regularly assigned to you. Supervisor/Manager
Employee leave Resolve formal grievances Select new employees Transfer/promotion action Disciplinary action Discharge action Adjust salary of staff Evaluate performance Give Input OR Give Input OR Give Input OR Give Input OR Give Input OR Give Input OR Give Input OR Give Input OR
Work/Team Leader
Instruct/mentor staff Assign work to staff Review work of staff Plan work of staff Maintain work standards Coordinate staff activities Reallocate/schedule staff Counsel employee problems
Level of Involvement
Recommend OR Recommend OR Recommend OR Recommend OR Recommend OR Recommend OR Recommend OR Recommend OR Final Approval Final Approval Final Approval Final Approval Final Approval Final Approval Final Approval Final Approval
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4. Machinery, Equipment, Tools, and Software Used:
List below the type(s) of machinery, equipment, tools, and/or software used or serviced in the performance of your duties. (Examples: typewriter, tractor, dump truck, computer terminal, adding machine, air conditioner, dialysis machine, drill press, offset press, mechanic’s or carpenter’s tools, drafting or artist’s instruments, surgical instruments, pick-ax, shovel or software such as Microsoft Word, D-base, EXCEL.) Beside each item, briefly describe the purpose for which you use or service it. (Examples: move material, produce items, or input/update expenses or accounting data.) Then, specify what is done with it. (Examples: tend it, operate it, repair it, maintain it., or set/design spreadsheets.) Type of Machinery, Equipment, Tools, Software, Etc. Purpose For Which This Item is Used or Serviced What is Done with it
5. Nature and Impact of Independent Decisions Made:
Describe the three most important decisions you normally make without higher approval or review. Who or what is affected by these decisions? (Examples: I determine the mission of an agency. I approve financial or material contracts worth X number of dollars. I determine the amount of benefits a client receives. I prescribe the type of medication for a patient. I dispense a prescription to the proper patient. I select the format in which to type a report.) Describe possible errors in judgment that might occur. What are the consequences of errors made? (Examples: Loss of program or agency reputation, Disruption of work, Waste of resources, Financial losses, Injury to self or others, Property damage, Legal actions.) Do not include errors that occur through gross negligence or failure to follow regulations or policies.
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6. Financial Responsibilities Assigned:
If your position has any financial (budgetary or procurement) responsibilities, complete the following table, showing the approximate annual value of the item over which you have financial approval, accountability, or signature authority. If this value varies from year to year, calculate the average amount. For each item listed below on the left, check (? ) all boxes that apply. Do not list any type if less than $1,500.00. Monitor, Track & Record Authorize Expenditures or Expenditures or Allocations Allocations (? ) (? )
Type of Item of Value
Dollar Amount
Justify Needs & Prepare Recommend Financial Data & Approve Final Requests Proposals Documents (? ) (? ) (? )
Salaries & Wages Equipment & Machinery Material & Supplies Grants (pass through funds) Program Services Contractual or Rental Services Travel & Lodging Other (specify)
$
$
$
$
$
$
$
$
TOTAL
$
I certify the responses provided in this questionnaire accurately and completely describe the current duties and responsibilities of this position.
Employee’s Signature
Date
After completing the next section of this questionnaire, please sign and date it, and then give it to your immediate supervisor for review. Thank you for your time and cooperation.
4/11/2002
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7. Questionnaire Evaluation:
This section allows you to give further feedback on your position and this job information questionnaire. a. Please describe other characteristics of your work that have not been covered in this questionnaire.
b. Please show the extent of your agreement or disagreement with each statement by checking (? ) the appropriate box. Strongly Disagree The questionnaire gave me an adequate opportunity to describe my position. The directions were easy to follow. The answer formats were easy to complete. The questions were reasonable. Disagree Neutral Agree Strongly Agree
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Supervisor’s and Management’s Review
1. Please review the employee’s responses carefully to see whether you think they provide an accurate and complete description of the position. If you disagree with the statements or pertinent information is missing, please list the section number and provide your comments below. Please clearly label each reviewer’s comments. The employee’s work performance will not be considered in the classification review of this position. DO NOT CHANGE ANY OF THE EMPLOYEE’S RESPONSES. Section Number Reviewer Comments
2. If this is a request to reclassify an existing position, briefly describe the reassignment of work, the new function added by law or other factors, or the reorganization which changed the duties and responsibilities of this position.
3. Briefly describe the essential purpose and contribution of this position to the mission of its work unit and/or to the programs of the agency. Describe what this position does, not the work done by the entire work unit. Explain the primary reason the position exists and the services or products and end results to be accomplished.
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4. QUALIFICATIONS: Check (? ) below the amount of work/life experience, education, training, and/or other requirements a person would need to have in order to successfully perform the duties and responsibilities of this position. Beside the items checked, describe what kinds of background minimally required and preferred. Minimum (? ) Preferred (? ) Amount of Experience Less than 1 year 1 year up to 2 years 2 years up to 3 years 3 years up to 5 years 5 years up to 7 years 7 years up to 10 years 10 or more years Minimum (? ) Preferred (? ) Level of Education, Vocational or other Training High School diploma or G.E.D. Vocational/Technical diploma Some college/Associate’s degree Bachelor’s degree Master’s degree Jurisprudence doctorate Doctorate degree Other Specific Major, Concentration, or Area of Learning Kind of Experience
5. SPECIAL REQUIREMENTS OF LAW: List any specific work related security clearance, training, trade apprenticeship, or professional specialty, licensure, registration, certification, or other designation needed to meet occupational requirements for this position. Please provide a copy of the source (e.g., state statute, federal regulation) of this requirement.
Yes 6. Would this position be eligible to receive overtime compensation? .......................................................................... 7. Would this position be covered by a labor contract?..................................................................................................
No
8. Attach to this questionnaire an agency organization chart showing where this position is located (circle or highlight the position on this chart). Please include the agency employees directly and indirectly supervised by this position, and at least two levels of supervisors immediately above this position. I certify the responses to this questionnaire accurately and completely describe the position based on my understanding of the current duties and responsibilities of this position, except as noted in the comments section above.
Supervisor’s Signature Division Director’s or Administrator’s Signature Agency Director’s or Designee’s Signature
Date Date Date
doc_813986895.pdf
A questionnaire is a research instrument consisting of a series of questions and other prompts for the purpose of gathering information from respondents. Although they are often designed for statistical analysis of the responses, this is not always the case. The questionnaire was invented by Sir Francis Galton.
4/11/2002
Page 1
Position Description Questionnaire
State of Nebraska DAS State Personnel
Office Use
Agency Information Agency: Division: Classification Information Current Class Title: Class Code: Salary Grade: Requested Class Title: Class Code: Salary Grade: Employee Information Employee Name: Employee Work Location: Employee Phone Number: Supervisor Information Immediate Supervisor Name: Supervisor Class Title: Supervisor Work Location: Supervisor Phone Number: Management completes this section This classification request is:
1. 2. 3. 4. Employee Initiated to Reclassify a Position for Position Number: Date submitted to DAS – State Personnel Division: OR OR Management Initiated to Create a Position OR OR State Personnel Initiated for Class Study or Update
4/11/2002
Page 2
Introduction to the Position Description Questionnaire
In completing this questionnaire, please respond to every section that applies to your position. After you complete the questionnaire, your supervisor and others will review it for completeness and accuracy, when they complete the “Supervisor’s and Management’s Review” section. Your responses are used to determine the ranking of your position relative to others in State government and aid in the operation of other human resource management activities. Your responses, therefore, need to be as complete and accurate as possible. They will not be used to evaluate your job performance, nor be seen as limiting the authority of an agency head or supervisor to assign work.
GENERAL INSTRUCTIONS (Please read these directions carefully.)
Before answering each section, please read through the entire questionnaire. If further space is needed to answer a section completely and accurately, please attach additional pages. If a section does not apply to your position, answer “not applicable or N/A.” Please type or, if you prefer, legibly write your responses onto the questionnaire.
1. Essential Duties of the Position:
In the first column of the table “List of Essential Duties Performed” on the next page, please describe the essential duties of this position in clear, concise statements. Begin each essential duty statement with an action verb such as: Drives, Conducts, Repairs, Files, Types, Answers, Summarizes, and Interprets. Avoid words having unclear meanings such as Assists, Performs, Provides, Handles, Maintains, Participates, and Deals with. Use examples if they would make the duties described more clear. Then, for each of these duties, mark the proper response under each of the next three columns using the following guidelines: • Percentage of Time: Estimate the percentage of time spent performing each duty. Do not include a duty which occupies less than 5% of your time unless it is essential to the position. The total of all percentages should account for between 90% and 100% of the position’s time. Whether you perform this duty on a daily, weekly, monthly, quarterly, or annual basis, the following chart will help you estimate the percent of time you spend doing it. Daily 1/2 hour 1 hour 1 1/2 hours 2 hours 2 1/2 hours Weekly 2 hours 4 hours 6 hours 8 hours 10 hours Monthly 1 days 2 days 3 1/2 days 4 1/2 days 5 1/2 days Quarterly 3 days 6 1/2 days 10 days 13 days 16 days Annually 2 1/2 weeks 5 weeks 8 weeks 10 weeks 13 weeks
Percentage 5% 10% 15% 20% 25% •
Most Critical: Rate how critical each duty is to the position’s overall work objectives. Use a rating scale of 1 to 5 (ranging from 1 being most critical to 5 being least critical). Duties performed infrequently or that do not involve a large amount of time may still be critical to the position. The same rating may be given to more than one duty. Newly Assigned Duty: Place a check mark (? ) in this column for those duties that have been newly assigned in the last six months and/or have been added since the last classification review.
•
4/11/2002
Page 3
List of Essential Duties Performed
(see previous page for coding instructions for each column) Percentage Critical New Duty
4/11/2002
Page 4
2. Data/Information Used:
a. List below the type(s) of reports, documents, charts, graphs, payments, etc., received and/or reviewed in the performance of your duties. Beside each item, briefly describe the purpose or reason you receive and/or review it. Then state what you do with it and/or the data/information contained in it, after it is received and/or reviewed. Purpose or Reason for Receiving It What is Done With It
Type of Record, Report, Chart, Etc.
b. List below the type(s) of records, reports, charts, graphs, etc. prepared in the performance of your duties. Beside each item, briefly describe the purpose of the document. Then state what is done with it after it is prepared. Type of Record, Report, Chart, Etc. Purpose or Reason for Preparing It What is Done With It
c.
List below the type(s) of manuals, texts, drawings, documents, etc., which are referred to or used in the performance of your duties. Beside each item, briefly describe the purpose for which you refer to it. Purpose for which it is Referred to
Type of Manual, Book, Drawing, Etc.
4/11/2002
Page 5
3. Interpersonal Communication/Interaction:
a. List those persons or groups with whom communication occurs in the performance of your duties. Beside each person, group, or organization listed, state the purpose for which the communication and/or interaction occurs. Purpose of Communication/Interaction
Person/Group with Whom Communication/Interaction Occurs
b. List the names and job titles of individuals you directly supervise. Beside each listing, note whether these are part- time or full-time positions, and, where applicable, the number of staff directly supervised by these individuals. Person(s) You Directly Supervise His or Her Job Title Part Time or Full Time Number of Staff He or She Supervises
c.
If your position involves leadership, supervisory, or managerial responsibilities for other staff, check (? ) below in the first two columns of boxes the responsibilities assigned to you on an on-going basis. Then check your level of involvement in supervising/managing employees regularly assigned to you. Supervisor/Manager
Employee leave Resolve formal grievances Select new employees Transfer/promotion action Disciplinary action Discharge action Adjust salary of staff Evaluate performance Give Input OR Give Input OR Give Input OR Give Input OR Give Input OR Give Input OR Give Input OR Give Input OR
Work/Team Leader
Instruct/mentor staff Assign work to staff Review work of staff Plan work of staff Maintain work standards Coordinate staff activities Reallocate/schedule staff Counsel employee problems
Level of Involvement
Recommend OR Recommend OR Recommend OR Recommend OR Recommend OR Recommend OR Recommend OR Recommend OR Final Approval Final Approval Final Approval Final Approval Final Approval Final Approval Final Approval Final Approval
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4. Machinery, Equipment, Tools, and Software Used:
List below the type(s) of machinery, equipment, tools, and/or software used or serviced in the performance of your duties. (Examples: typewriter, tractor, dump truck, computer terminal, adding machine, air conditioner, dialysis machine, drill press, offset press, mechanic’s or carpenter’s tools, drafting or artist’s instruments, surgical instruments, pick-ax, shovel or software such as Microsoft Word, D-base, EXCEL.) Beside each item, briefly describe the purpose for which you use or service it. (Examples: move material, produce items, or input/update expenses or accounting data.) Then, specify what is done with it. (Examples: tend it, operate it, repair it, maintain it., or set/design spreadsheets.) Type of Machinery, Equipment, Tools, Software, Etc. Purpose For Which This Item is Used or Serviced What is Done with it
5. Nature and Impact of Independent Decisions Made:
Describe the three most important decisions you normally make without higher approval or review. Who or what is affected by these decisions? (Examples: I determine the mission of an agency. I approve financial or material contracts worth X number of dollars. I determine the amount of benefits a client receives. I prescribe the type of medication for a patient. I dispense a prescription to the proper patient. I select the format in which to type a report.) Describe possible errors in judgment that might occur. What are the consequences of errors made? (Examples: Loss of program or agency reputation, Disruption of work, Waste of resources, Financial losses, Injury to self or others, Property damage, Legal actions.) Do not include errors that occur through gross negligence or failure to follow regulations or policies.
4/11/2002
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6. Financial Responsibilities Assigned:
If your position has any financial (budgetary or procurement) responsibilities, complete the following table, showing the approximate annual value of the item over which you have financial approval, accountability, or signature authority. If this value varies from year to year, calculate the average amount. For each item listed below on the left, check (? ) all boxes that apply. Do not list any type if less than $1,500.00. Monitor, Track & Record Authorize Expenditures or Expenditures or Allocations Allocations (? ) (? )
Type of Item of Value
Dollar Amount
Justify Needs & Prepare Recommend Financial Data & Approve Final Requests Proposals Documents (? ) (? ) (? )
Salaries & Wages Equipment & Machinery Material & Supplies Grants (pass through funds) Program Services Contractual or Rental Services Travel & Lodging Other (specify)
$
$
$
$
$
$
$
$
TOTAL
$
I certify the responses provided in this questionnaire accurately and completely describe the current duties and responsibilities of this position.
Employee’s Signature
Date
After completing the next section of this questionnaire, please sign and date it, and then give it to your immediate supervisor for review. Thank you for your time and cooperation.
4/11/2002
Page 8
7. Questionnaire Evaluation:
This section allows you to give further feedback on your position and this job information questionnaire. a. Please describe other characteristics of your work that have not been covered in this questionnaire.
b. Please show the extent of your agreement or disagreement with each statement by checking (? ) the appropriate box. Strongly Disagree The questionnaire gave me an adequate opportunity to describe my position. The directions were easy to follow. The answer formats were easy to complete. The questions were reasonable. Disagree Neutral Agree Strongly Agree
4/11/2002
Page 9
Supervisor’s and Management’s Review
1. Please review the employee’s responses carefully to see whether you think they provide an accurate and complete description of the position. If you disagree with the statements or pertinent information is missing, please list the section number and provide your comments below. Please clearly label each reviewer’s comments. The employee’s work performance will not be considered in the classification review of this position. DO NOT CHANGE ANY OF THE EMPLOYEE’S RESPONSES. Section Number Reviewer Comments
2. If this is a request to reclassify an existing position, briefly describe the reassignment of work, the new function added by law or other factors, or the reorganization which changed the duties and responsibilities of this position.
3. Briefly describe the essential purpose and contribution of this position to the mission of its work unit and/or to the programs of the agency. Describe what this position does, not the work done by the entire work unit. Explain the primary reason the position exists and the services or products and end results to be accomplished.
4/11/2002
Page 10
4. QUALIFICATIONS: Check (? ) below the amount of work/life experience, education, training, and/or other requirements a person would need to have in order to successfully perform the duties and responsibilities of this position. Beside the items checked, describe what kinds of background minimally required and preferred. Minimum (? ) Preferred (? ) Amount of Experience Less than 1 year 1 year up to 2 years 2 years up to 3 years 3 years up to 5 years 5 years up to 7 years 7 years up to 10 years 10 or more years Minimum (? ) Preferred (? ) Level of Education, Vocational or other Training High School diploma or G.E.D. Vocational/Technical diploma Some college/Associate’s degree Bachelor’s degree Master’s degree Jurisprudence doctorate Doctorate degree Other Specific Major, Concentration, or Area of Learning Kind of Experience
5. SPECIAL REQUIREMENTS OF LAW: List any specific work related security clearance, training, trade apprenticeship, or professional specialty, licensure, registration, certification, or other designation needed to meet occupational requirements for this position. Please provide a copy of the source (e.g., state statute, federal regulation) of this requirement.
Yes 6. Would this position be eligible to receive overtime compensation? .......................................................................... 7. Would this position be covered by a labor contract?..................................................................................................
No
8. Attach to this questionnaire an agency organization chart showing where this position is located (circle or highlight the position on this chart). Please include the agency employees directly and indirectly supervised by this position, and at least two levels of supervisors immediately above this position. I certify the responses to this questionnaire accurately and completely describe the position based on my understanding of the current duties and responsibilities of this position, except as noted in the comments section above.
Supervisor’s Signature Division Director’s or Administrator’s Signature Agency Director’s or Designee’s Signature
Date Date Date
doc_813986895.pdf